Document Detail

Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature.
MedLine Citation:
PMID:  18181739     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Respiratory syncytial virus (RSV) causes significant mortality in patients with hematological diseases, but diagnosis and treatment are uncertain. METHODS: We retrospectively identified RSV-infected patients with upper or lower respiratory tract infection (RTI) by culture, antigen testing, and polymerase chain reaction from November 2002 through April 2007. Patients with severe immunodeficiency (SID; defined as transplantation in the previous 6 months, T or B cell depletion in the previous 3 months, graft-versus-host disease [grade, >or=2], leukopenia, lymphopenia, or hypogammaglobulinemia) preferentially received oral ribavirin, intravenous immunoglobulin, and palivizumab. The remaining patients with moderate immunodeficiency (MID) preferentially received ribavirin and intravenous immunoglobulin. RESULTS: We identified 34 patients, 22 of whom had upper RTI (10 patients with MID and 12 with SID) and 12 of whom had lower RTI (2 with MID and 10 with SID). Thirty-one patients were tested by polymerase chain reaction (100% of these patients had positive results; median RSV load, 5.46 log(10) copies/mL), 30 were tested by culture (57% had positive results), and 25 were tested by antigen testing (40% had positive results). RSV-attributed mortality was 18% (6 patients died) and was associated with having >or=2 SID factors (P=.04), lower RTI (P=.01), and preengraftment (P=.012). Among 12 patients with MID (7 of whom received treatment), no progression or death occurred. Nine patients with SID and upper RTI received treatment (7 patients received ribavirin, intravenous immunoglobulin, and palivizumab); infection progressed to the lower respiratory tract in 2 patients, and 1 patient died. Ten patients with SID and lower RTI were treated, 5 of whom died, including 4 of 6 patients who received ribavirin, intravenous immunoglobulin, and palivizumab. The duration of RSV shedding correlated with the duration of symptoms in patients with SID but exceeded symptom duration in patients with MID (P<.05). CONCLUSIONS: Lower RTI, >or=2 SID criteria, and preengraftment are risk factors for RSV-attributed mortality. Polymerase chain reaction may optimize diagnosis and monitoring. Oral ribavirin therapy seems safe, but trials are needed to demonstrate its efficacy.
Nina Khanna; Andreas F Widmer; Michael Decker; Ingrid Steffen; Jörg Halter; Dominik Heim; Maja Weisser; Alois Gratwohl; Ursula Fluckiger; Hans H Hirsch
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  46     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-09     Completed Date:  2008-03-06     Revised Date:  2008-07-03    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  402-12     Citation Subset:  IM    
Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
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MeSH Terms
Cell Culture Techniques
Hematologic Diseases / immunology,  therapy,  virology*
Hematopoietic Stem Cell Transplantation / methods
Immunocompromised Host
Immunoglobulins, Intravenous / immunology,  therapeutic use
Respiratory Syncytial Virus Infections / complications*,  immunology,  therapy,  virology
Respiratory Syncytial Viruses / isolation & purification*
Respiratory Tract Infections / complications,  immunology,  virology
Retrospective Studies
Reverse Transcriptase Polymerase Chain Reaction / methods
Ribavirin / therapeutic use
Reg. No./Substance:
0/Immunoglobulins, Intravenous; 36791-04-5/Ribavirin
Comment In:
Clin Infect Dis. 2008 Jun 15;46(12):1933-4; author reply 1934-5   [PMID:  18540811 ]

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